Ohio is ground zero in fight against opioid abuse, but is Trump administration focused enough on problem? – News – The Columbus Dispatch

WASHINGTON C.H. — In a dungeon-like jail in the center of this farming town, 18 women in orange-and-white-striped prison uniforms are crammed into a two-story cellblock. Many of them are withdrawing from fentanyl.

The jail, built in 1884 to hold 24, now houses 55 men and women, a number that can swell on any given day to as many as 90. The inmates are sprawled on metal bunk beds and mattresses that line the floors as they wait for court appearances or serve time on low-level drug offenses.

The medical exam room, used to treat minor ailments, is tucked into a broom closet beneath a concrete stairwell. With few drug-treatment options, prisoners addicted to fentanyl go through days of withdrawal with little help, shivering and curled up on the beds and floors of the jail.

“It’s definitely our detox center right now. They just sit there, and they withdraw there,” Fayette County Deputy Health Commissioner Leigh Cannon said. “Treatment is where we need help. We keep hearing that money is coming, but we haven’t really seen it.”

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Fayette County, 40 miles southwest of Columbus, has the seventh-highest number of fentanyl overdose deaths per capita in the nation, according to data from the Centers for Disease Control and Prevention analyzed by the Washington Post.

Though the Trump administration has made the opioid epidemic a priority, people in communities across the country continue to die in record numbers from fentanyl, and health officials are struggling to provide treatment for tens of thousands more, like the men and women warehoused in the Washington Court House jail.

President Donald Trump has taken a number of steps to confront the crisis, stem the flow of fentanyl into the country from China and Mexico, and step up prosecutions of traffickers. Congress also has increased spending on drug treatment.

But health policy experts say that drug treatment funding is not nearly enough, and the administration’s response was hobbled by the failure to appoint a drug czar in its chaotic first year and confusion over who was in charge of drug policy. The administration has yet to produce a comprehensive strategy, something that is legally required by Congress.

John Walters, director of the White House Office of National Drug Control Policy during the George W. Bush administration, said that after two years and a presidential commission to study the problem, the Trump administration is still struggling to confront the deadliest drug crisis in U.S. history and is not dedicating nearly enough federal resources.

“What other threat that is preventable is going to kill tens of thousands of Americans?” Walters said. “We’re spending much more money on terrorism, as we should, but we’re not spending a similar amount on the source of death to many more Americans right now.”

In 2017, the first year of the Trump presidency, a record 28,869 people died of overdoses related to synthetic opioids, a 46.4% increase from the year before. Most were from fentanyl, which is 50 times more powerful than heroin. Estimates for the first eight months of 2018, the most recent data available, show that an additional 20,537 Americans died — a toll on pace to exceed the previous year’s.

Public health experts also note that the administration is seeking to repeal the Affordable Care Act and cut $1.5 trillion over 10 years from Medicaid. More than 500,000 people addicted to opioids could lose their drug treatment coverage if the Affordable Care Act is repealed, according to the Kaiser Family Foundation. The proposed Medicaid cuts could further reduce coverage.

Last August, Columbus and three other cities sued the administration for undermining the act. The cities — Baltimore, Chicago, Cincinnati and Columbus — accused the administration of actively discouraging enrollment, raising rates and limiting health-care services.

Trump officials said they are making progress against the epidemic on a range of fronts, including interdiction, prosecution and treatment, but they acknowledge that it remains a huge challenge.

“We didn’t get into this crisis overnight. We’re not going to get out overnight,” Kellyanne Conway, counselor to the president and the administration’s leading voice on the epidemic, said in an interview.

The CDC data obtained by the Post documents for the first time the 10 places with the highest per-capita fentanyl-related overdose death rates: five counties in Ohio, two in West Virginia and one in Kentucky, and the cities of Baltimore and St. Louis. Local health officials told the Washington Post that they still are not receiving enough federal money to fund drug treatment programs to wean people off highly addictive opioids or launch prevention programs to warn people of the dangers of fentanyl.

In Ohio, deaths from fentanyl have ravaged vast sections of the state. In 2015, there were 1,255 deaths related to synthetic opioids, most from fentanyl. By the end of 2017, that number had nearly tripled to 3,572.

In rural counties of Ohio, federal money recently appropriated by Congress has started to arrive, but health officials there say it is not enough.

“The situation four years ago was looking desperate. Today, it’s looking dire,” said Scott Gehring, president of the Community Health Alliance, a drug treatment facility in Butler County, which has the ninth-highest fentanyl overdose death rate in the nation. “People are sicker. More people are dying.”

A scattered response

Obama administration officials were slow to address the fentanyl epidemic, seeing the drug as an add-on to the overall opioid crisis rather than a singular danger that required a strategy of its own.

But by the time Trump came into office, the dangers of fentanyl were well known. The Drug Enforcement Administration and the CDC had issued numerous warnings. The fatal overdose rate was staggering.

On the urging of then-New Jersey Gov. Chris Christie, Trump established the President’s Commission on Combating Drug Addiction and the Opioid Crisis in March 2017 and put Christie in charge. Attorney General Jeff Sessions was pursuing his own effort to curb drug use by returning to a policy of aggressive sentencing for both drug traffickers and drug users.

But the White House Office of National Drug Control Policy, responsible for coordinating anti-drug efforts across 16 federal agencies and producing an annual drug policy plan mandated by Congress, became a backwater. The White House staffed it with political operatives who had little or no drug policy experience and sidelined senior staffers with years of experience. In May 2017, the administration proposed cutting the office’s budget by 95%.

The opioid overdose death rate continued to climb. In 2017, fentanyl for the first time became the leading cause of overdose deaths in America.

After eight months in office, Trump nominated Rep. Tom Marino, R-Pa., for the drug czar position, but it was discovered that Marino had close ties to the opioid industry that had swayed his policymaking before. He withdrew from the nomination in October.

A week later, Trump took Christie’s advice and made a move that Obama officials had failed to make when he declared fentanyl a public health emergency.

But two things were missing: money and a detailed plan.

“When you say this is an emergency, you would expect to hear what they plan to do about the emergency,” said Andrew Kolodny, co-director of opioid policy research at Brandeis University in Waltham, Massachusetts. “When President Trump designated the opioid crisis a public health emergency, at the very same time, he should have said, ‘Here’s what we’re going to do about it,’ and put out a detailed plan outlining what every federal agency was going to do.”

On Nov. 1, Christie’s commission released its final report, with 56 recommendations on the opioid crisis. Some drug policy experts criticized the commission for taking too long and repackaging old ideas instead of crafting a new strategy.

It called for launching an anti-opioid public relations campaign, providing more funding for drug treatment and continuing to target traffickers. The report also called for access to medicine designed to wean people off opioids and to naloxone, a medication that reverses overdoses.

A few weeks later, Trump named Conway, a former Republican Party pollster, as his point person on the opioid epidemic. A highly skilled political operative with no drug policy experience, Conway was now in charge of coordinating the government’s response to the epidemic.

‘Overwhelming the system’

In Ohio, fentanyl is ravaging parts of the state and “overwhelming the system,” Sen. Rob Portman, R-Ohio, said. Though the overall drug overdose death toll declined by 21% in the state between 2017 and 2018, deaths from fentanyl continue to rise. The senator has sponsored legislation to increase federal funding to help the hardest-hit areas of the country. Since 2017, Ohio has received $140 million from the federal government, but Portman said he knows it’s not enough.

In Clark County, outside Dayton, fentanyl overdoses are fueling large cost overruns for government services — foster care, paramedics and police. Health-care officials and drug treatment experts in Clark County say they are starting to see drug treatment money from Washington, but more is needed. Ending the Affordable Care Act or cutting Medicaid, they said, would be disastrous.

On Jan. 2, the Senate confirmed James Carroll to be Trump’s first permanent drug czar. Former counsel to the Ford Motor Co., Carroll had been appointed acting drug czar in February 2018.

Despite attempts by the Office of Management and Budget to slash his budget, Carroll said he has the full support of the White House. He acknowledged that the government needs to spend more money and move faster.

Kellyanne Conway noted that the administration is fighting the opioid epidemic by launching an ad campaign; having better detection protocols at ports of entry and the U.S. Postal Service; and improved data collection. The administration has formed an “opioid cabinet” with representatives of key government agencies, and Conway said they have secured an additional $6 billion from Congress to combat the crisis.

For Rep. Elijah Cummings, D-Md., the fentanyl epidemic has hit home; he has represented Baltimore both in the state capital and in Washington for 36 years. He has co-sponsored legislation that calls for spending $100 billion to combat the opioid epidemic and called out the administration for failing to release a full strategy to do so.

“The White House office charged with leading our nation’s efforts to combat the drug crisis has been missing in action as deaths continue to mount,” Cummings said. “The White House had no national drug control strategy. None. None. All while tens of thousands of people were dying and the crisis was escalating every day.”